Capítulo II. Satisfacción y factores psicosociales en el ámbito laboral
2.2. Delimitación conceptual de la satisfacción laboral
2.2.1. La satisfacción laboral desde el punto de vista de la Psicología
payroll and insurance.”
17The best support services are able to flex their ‘offer’ according to individual needs and preferences. For example, a family carer who has had a lot of experience with managing a personal budget for social care for their son or daughter may need only minimal support with a personal health budget initially, but may want this to increase as they get older and more frail themselves. More significant change may be required at such a time; for example, many parents would say that they do not want their non-disabled children to feel obliged to take on full responsibility for managing a personal budget for their brother or sister, though they might well feel able to take on some aspects in addition to being an important member of their relative’s circle.
There is much that can be learned from the implementation of personal budgets within local authorities, with regard to both what to adopt and what to avoid, as there are significant variations in performance. For example, see the Think Local Act Personal review of personal budgets for older people: www.thinklocalactpersonal.org.uk/News/PersonalisationNewsItem/?cid=9426
There is a risk that people who have a learning disability and who also lack capacity to manage a personal health budget themselves will be left out, particularly if they do not have active family members involved. Third party budgets can be of particular value for this group; for example, individual service funds (ISFs) improve choice and control, and have been found to be beneficial for people who were (or were at risk of becoming) inpatients in assessment and treatment units. Mental Capacity Act principles apply to choice of budget management options just as they do to designing support – good practice involves listening to and involving the person and those who know and care about them, supporting decision making, and making best interests decisions where necessary.
What we have learnt so far
What is going well locally
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Kent: have a ‘Kent card’ (a card loaded with money that people can use).•
Somerset: the brokerage service can support people with managing their budget.•
Nottingham City: people can pool their budgets (or part of them) to achieve something together that neither could afford alone.•
Nottingham City: people who have both a personal budget and a personal health budget can have these ‘joined up’ through the brokerage organisation.•
Dorset: some family carers are getting together to form a third party organisation.Issues and challenges
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Maintaining flexibility and creativity once personal health budgets become more common and a commissioner can no longer be so directly involved in each individual plan.•
Developing a market of third party organisations to allow choice and meet local demand, and ensuring that budgets include a realistic allowance for such organisations’ essential central costs, such as training and supervision.•
Some areas have encountered difficulties in working effectively with the Court of Protection and Court-appointed Deputies to ensure that people who lack capacity to manage apersonal health budget are not left out. This can be a particular issue for people who do not have actively involved family carers or others who can represent their interests.
Short examples of good practice
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Hull suggest that in ‘scaling up’ there should be a distinction between essential requirements on individual budget holders and discretionary advice. For example, a CCG could set a requirement that all employers must have employer’s liability insurance, but could decide for themselves whether or not to seek CRB (now Disclosure and Barring Service) checks.•
Hull: the User Led Organisation, personal health budget team and local credit union work together and tailor their support regarding budget management to meet individual needs.•
Dorset: the support agency can manage the payroll and work with a direct payment support service that that can act as a banker and accountancy service, removing many complications from personal health budget packages.Practical tools/resources
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Independent user trusts and other third party optionsThis guide to independent user trusts sets out core principles, steps to setting up and considerations around governance.
Fitzgerald, J. (2011) Personal Health Budgets and Independent User Trusts. Blackburn: Mitchell James Ltd.): www.in-control.org.uk/what-we-do/health-programme/latest publications/personal-health-budgets-and-independent-user-trusts.aspx
Department of Health (2012) Transforming care: A national response to Winterbourne View Hospital. Department of Health review – final report. London: Department of health:
www.gov.uk/government/publications/winterbourne-view-hospital-department-of-health review-and-response
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Gives examples of using individual service funds (ISFs)Tomlinson, C.l. and Livesley, M. (2013) Individual Service Funds for Homecare. Wythall: In Control: www.in-control.org.uk/publications/reports-and-discussion-papers/individual-service
Marker 16: We check with
the person and family to see
how well things are going
Why is this important for people with learning
disabilities and their families?
People with learning disabilities and families using personal health budgets are the best source of information on their effectiveness, and timely reviews (focused on outcomes) can maximise effectiveness and cost effectiveness. People should also have a range of ways of asking for advice or change in between formal review dates; developing relapse or contingency plans is one way of formalising this. The abuse at Winterbourne View showed what can happen when the voices of people using services and family carers are not heard.
Gathering information on outcomes and sharing learning about what works (and what does not), is also important for future service development and strategic buy-in. For example, the national collaboration for integrated care and support emphasises the importance of strategic support and scrutiny from Health and Wellbeing Boards, but they will need good information about the impact of personal health budgets in order to support their roll-out. Any system for collecting information should focus on outcomes.